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Feasibility, stability and validity of the four square step test in typically developed children and children with
Gil Leizerowitz1, Michal Katz-Leurer1,2
1a Sackler Faculty of Medicine, School of Health Professions, Physical Therapy Department , Tel-Aviv University , Tel-Aviv , Israel.
Insights
The lenient Four Square Step Test (FSST) is feasible, reliable, and valid for typically developed children and those with cerebral palsy. This balance test shows promise for assessing mobility in pediatric populations.
Area of Science:
- Pediatric physical therapy
- Neurological rehabilitation
- Motor function assessment
Background:
- Assessing balance and mobility is crucial for children with neurological conditions like cerebral palsy (CP) and acquired brain injury (ABI).
- The Four Square Step Test (FSST) is a common tool, but its applicability in pediatric populations, especially those with motor impairments, requires investigation.
- Understanding the feasibility, reliability, and validity of modified assessment tools is essential for effective clinical practice and research.
Purpose of the Study:
- To evaluate the feasibility, test-retest reliability, and validity of the Four Square Step Test (FSST) in typically developing (TD) children, and children with cerebral palsy (CP) and acquired brain injury (ABI).
- To determine if a modified, more lenient version of the FSST improves its applicability in pediatric populations with motor challenges.
Main Methods:
- The study included 30 TD children, 20 with CP, and 12 with ABI.
- Participants underwent the FSST (sitting and standing), Timed Up and Go (TUG), and the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2) balance subtest.
- The FSST was administered twice within a week, using both original (two successes) and lenient (one success) scoring criteria.
Main Results:
- The original FSST was not feasible for children with CP or ABI.
- The lenient FSST demonstrated feasibility (93% TD, 80% CP) and moderate-to-good reliability (ICC=0.723 TD, rs=0.83 CP).
- The lenient FSST showed significant correlations with TUG (TD, rs=0.56) and BOT-2 (CP, rs=-0.69), indicating validity.
Conclusions:
- The lenient version of the Four Square Step Test is a feasible, reliable, and valid measure for typically developing children and those with cerebral palsy.
- The original FSST is not suitable for children with CP or ABI.
- Further research is needed to explore the utility of the FSST in children with acquired brain injury.
Purpose:
To assess feasibility, test-retest reliability and validity of the Four Square Step Test (FSST) in typically developed children (TD), and children with cerebral palsy (CP) and acquired brain injury (ABI).
Methods:
30 TD children, 20 with CP and 12 with ABI participated in the study. The FSST while sitting and standing, the Timed Up and Go (TUG) and the balance subtest of the Bruininks-Oseretsky Test (BOT-2) were assessed. Each child attempted the FSST twice within 1 week. The scores for the FSST were assigned according to the original test: two successes in four trials, and according to a more lenient test, one success in four trials.
Results:
The original form of the FSST is not feasible for children with CP or ABI. In TD children the lenient version is feasible (93%) and has moderate stability (Interclass correlation, ICC = 0.723), with a significant, positive correlation with the TUG (rs = 0.56). In children with CP the lenient test is feasible (80%), stable (rs = 0.83) and negatively correlates with the BOT-2 (rs=-0.69). In children with ABI the test is less feasible (67%) and neither stable nor valid.
Conclusions:
The lenient form of the FSST is feasible, reliable and valid in TD children and children with CP.
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